Is it best to see a therapist face to face? Or can zoom therapy help me just as much? Are there ways in which zoom therapy can be even better than face to face?
When I was first asked to do therapy over Zoom, I didn’t want to. That has changed. Here’s why.
In recent years, particularly since corona changed humanity as we know it, we are constantly faced with dilemmas that force us to choose between convenience of connection and depth of connection. Social media, WhatsApp, and other forms of online connection now offer us opportunities to connect with people with similar ideas and values worldwide. At the same time, having the ease to connect within the comfort of our own homes has the downside of leaving us in the comfort of our own homes! Meaning that we are less likely to get out of our comfort zone and connect face to face.
This leads to many predicaments that can be challenging to navigate.
These shifting realities have affected how we learn and teach, how we create and participate in
community, how we celebrate family occasions, and how we do therapy. As little as five years ago it was standard that therapy take place face-to-face in an office or clinic; now, for many clients that has become a thing of the past. More and more clients are finding that the convenience and accessibility of online or Zoom therapy sessions make much more sense in their current life reality than seeing a therapist face-to-face.
With all of the convenience of online connections, they are fundamentally different from the reality of connection to another human face-to-face. Is it worth it? Depends.
What are the pros and cons of Zoom sessions compared to face-to-face visits, and how can the
downsides of Zoom sessions be addressed, so that people can make the most of that option if that is the best one that is available to them?
The Pros of Zoom sessions:
1. Accessibility: One of the most significant advantages of conducting trauma therapy sessions
by Zoom is the accessibility it provides. For individuals who live in remote areas or have
limited mobility, online therapy can provide mental health support that may otherwise be
out of reach. Particularly for frum clients, it is often important to find a therapist who shares
and respects their values. In small town or rural communities they may have very few
options. Even if there is a good therapist in town, not everyone wants to bump into their
therapist at the one kosher market, the neighbor’s bar mitzvah and the bikkur cholim
fundraiser. Finding a therapist online means that there are many more professionals that
could be available to help them, while not compromising their sense of privacy within their
community.
Sometimes symptoms of depression and anxiety are so harsh that people find that they aren't able to leave their homes. In such situations, online therapy can be virtually life saving.
2. Comfort and Convenience: Zoom sessions allow clients to participate from the safety and
comfort of their own homes. This can lead to a relaxed and open atmosphere, as clients feel
more at ease in their familiar surroundings. I’ve found that for many people, the
vulnerability that is inherent to good therapy is extremely uncomfortable. Being able to curl
up comfortably in one’s own home, and share their dark side with someone in another state
or on another continent can feel much more comfortable and safe than opening up to
another human in the same room. I believe that ideally people can reach a greater state of
health when they can learn to feel vulnerable safely in a room with others; for some, Zoom
sessions are a safe intermediate step.
3. Learning to listen inwardly. A human mind can be compared to a smartphone that has
cameras facing in two directions, the regular cam and the selfie cam. We too have the
capacity to focus on what is going on around us, as well as to focus on what is going on
within us. Most of us spend the majority of our time with our ‘outer world camera’ on. To do
good therapy and change the landscape of our inner world, we need to learn to safely turn
on our inner ‘selfie cam’ and get a sense of what is going on inside. I have found that some
clients have an easier time doing that when they are in a room alone and seeing a therapist
on a screen. Having the therapeutic presence not be three dimensional in the room can
make it feel safer to go inside and become aware and more comfortable with layers of
thoughts, feelings and sensations that were previously unexplored. When children are
exposed to emotional chaos, dysregulated caregivers and a lot of stress early in life, they
need to learn to have their antenna up and be constantly taking read of the world around
them in order to predict the moods and responses of the people around them. When these
children grow up and want to heal the wounds of the past, it can help them to have an
opportunity to do deep healing work without the nervous system activation, or stress that
comes from being in a new space and in a room with a new person (therapist). When I first
started doing therapy on zoom, it was with a client of mine who I had previously worked
with face to face, and when she needed to leave the country we continued on zoom. I asked
her a few sessions in if she felt that the work we were doing on zoom was as helpful to her
as what we had done in the office together, and she said yes. She said that she is so used to
figuratively taking the pulse of the emotions of everyone around her. And while she had
come to trust me, it was still easier for her to get a read on her own pulse when she was in
her room alone.
4. Reduced Stigma: For some, the anonymity provided by teletherapy can reduce the stigma
often associated with seeking mental health support. This may encourage more individuals
to explore trauma therapy. Some people who would otherwise put off reaching out to a
therapist, might feel more courage to take the first steps when the connection feels more
anonymous. Time can be of the essence when people are in need of help; delaying reaching
out can allow symptoms to fester and become more severe.
5. Time and Cost-Efficiency: Teletherapy saves time and money on commuting to a therapist's
office. This can be especially helpful for clients with busy schedules or financial constraints.
Many people today are living in a high-stress crunch of obligations to family, work, schooling
and community. Leaving home to drive, find parking, and see a therapist face-to-face can
end up taking three times as long as meeting someone on Zoom. Many clients find that it is
much easier to stick to their plan of a full course of therapy when it streamlines more easily
with their schedules.
The Cons of Zoom sessions:
1. Limited Non-Verbal Cues: A significant challenge in online therapy, particularly with EMDR,
somatic approaches and IFS, is the limitation on the therapist’s ability to observe non-verbal
cues. Therapists rely on facial expressions and body language to assess clients' emotional
states, which can be challenging over Zoom. If you do chose online therapy, make a point of
updating your therapist on the physical sensations you are feeling, and other non-verbal
cues that they might have picked up on if the two of you were in a room together. For
instance, tell the therapist, “I don’t know if you notice the tears coming up,” or “My breath
feels heavier when I start thinking about…”
2. Technical Issues: Internet connectivity problems or technical glitches can disrupt the
therapeutic process, potentially undermining the effectiveness of trauma therapy. It can be
frustrating and discouraging when you finally have the courage to open up something scary
or vulnerable, and then the therapist misses a sentence or two because of a “freeze” in the
connection. This is an unfortunate price that we pay for the conveniences of Zoom therapy.
Do your best to have patience and pick up from where things left off.
3. Privacy Concerns: Maintaining privacy during online therapy is vital. Clients must have a
confidential space for their sessions, which can be a challenge in shared living environments.
When a client is discussing challenges with another member of the family or household, it is
essential for them to find a space where they can discuss things freely without concerns of
being overheard. Many of my clients have found some creative and resourceful solutions for
this, such as parking their cars somewhere with good reception and meeting there, or having
sessions at hours when they have the house to themselves. Sometimes differences in time
zones can work on our favor here. One of my clients who is a night owl, loved being able to
see me at 2am her time, when the house was quiet, and I was ready to start my day of work!
4. Absence of Physical Presence: Imagine sitting in a room with someone that you love. Just
their presence or energy can shift how you feel, without them saying anything. In good
therapy, this is sometimes also the case. I have definitely felt moments of energetic
attunement with clients over Zoom, but it takes more effort, and often does not come as
easily. Also some trauma therapies involve tools and props that are harder to replicate
online. I, for instance, like using EMDR tappers in sessions, as well as sand tray therapy,
scents, toys and props. There are many solutions available today to navigate those
challenges, but it’s not the same.
5. The Therapeutic Relationship: Building a strong therapeutic alliance is crucial in trauma
therapy. Establishing trust can be more challenging online, as the screen can create a
perceived emotional distance between therapist and client. Many clients find that it is easier
to feel a real connection face to face, yet sometimes when clients haven’t had many good
trusting experiences with other people, having a screen between client and therapist can
make the client feel safer and make it easier to tentatively reach out and build an initial
sense of trust.
6. Distractions: Home environments may introduce more distractions, making it difficult for
clients to focus fully on the therapeutic process. Seeing a pile of bills or homework on your
desk, or laundry and mess in the background can make it hard to focus. Having family
members interrupt, receiving calls or messages on the device you are using to meet with the
therapist, or hearing sounds and conversations in the background can make it difficult to be
fully present. If you are meeting on Zoom, take a few minutes before the session to set
yourself up for success. Set up ‘do not disturb’ on your device, let family members know that
you won’t be available for the next hour or so, and set up your space in a way that will allow
you a sense of inner peace and comfort.
In conclusion, there are pros and cons to doing trauma therapy over Zoom. While the convenience and accessibility of teletherapy are undeniable advantages, there are also significant limitations. Choosing between in-person or online trauma therapy ultimately depends on individual circumstances, personal preferences, and the specific treatment approach. It is essential for both therapists and clients to weigh these factors and make an informed choice that best suits their unique needs.
Current research seems to show that teletherapy is as helpful and effective as face-to-face therapy.
For many people the convenience and access to good care that comes with telehealth makes the difference that enables them to actually reach out and get help.
If you are considering trying Zoom therapy, and aren’t sure if it is right for you, you are welcome to reach out to me and discuss the pros and cons in your current situation. I’m happy to offer a 10-15 minute free Zoom/WhatsApp chat to see if meeting together that way would be a good fit for you. You can reach me at shalvila@gmail.com, or on whatsapp +972524242234.